What is the role of oral anticoagulation after cerebral ischemia?

Updated: Dec 18, 2018
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

In patients with cerebral ischemia of unknown origin who are younger than 40 years, a search for hereditary thrombophilia is generally recommended. Oral anticoagulation after cerebral ischemia is usually recommended for patients with the following disorders:

  • Antithrombin III deficiency (target INR 2.5, range 2-3)

  • Protein C deficiency (target INR 3, range 3-3.5)

  • Protein S deficiency (target INR 2.5, range 2-3)

  • Activated protein C (APC) resistance (factor V Leiden; target INR 2.5, range 2-3)

  • Plasminogen deficiency/inhibition (target INR 2.5, range 2-3)

  • Dysfibrinogenemia (target INR 2.5, range 2-3)

As an alternative to oral anticoagulants, patients with thrombophilia may be treated with fixed, low-dose subcutaneous unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH). Patients with antithrombin III deficiency can receive antithrombin III concentrates for acute intervention or LMWH.

After a single event of thrombosis or thromboembolism, anticoagulation should be continued for at least 6 months. After recurrent or life-threatening thrombosis or in the case of a combination of different thrombophilias, lifelong anticoagulation is usually recommended.


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